Active NPI
Taylor Jordan Lewallen, RD
- Registered Dietitian
- Poway, CA
National Provider Identifier
1386218220
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Registered Dietitian
- License
- 8608987
- Practice address
- 13935 Putney Rd
Poway, CA 92064-3427 - Phone
- (623) 238-3452
- NPI assigned
- May 15, 2021
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Registered Dietitian | 133V00000X | 8608987 | AZ | Primary |
Addresses
Primary practice location
13935 Putney Rd
Poway, CA 92064-3427
Mailing address
13935 Putney Rd
Poway, CA 92064-3427
Phone (623) 238-3452
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 8608987 | AZ | MD | Registered Dietitian |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Temecula Dietitians, Inc. | Dietitian, Registered | Past | Accepting new patients |
| Nourish, Inc. | Dietitian, Registered | Past | Accepting new patients |
Organizations & group practices 2
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1621036800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1621036800000",
"number": "1386218220",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "13935 PUTNEY RD",
"city": "POWAY",
"state": "CA",
"postal_code": "920643427",
"telephone_number": "623-238-3452"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "13935 PUTNEY RD",
"city": "POWAY",
"state": "CA",
"postal_code": "920643427",
"telephone_number": "623-238-3452"
}
],
"practiceLocations": [],
"basic": {
"last_name": "LEWALLEN",
"first_name": "TAYLOR",
"middle_name": "JORDAN",
"credential": "RD",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2021-05-15",
"last_updated": "2021-05-15",
"certification_date": "2021-05-15",
"status": "A"
},
"taxonomies": [
{
"code": "133V00000X",
"taxonomy_group": "193400000X SINGLE SPECIALTY GROUP",
"desc": "Dietitian, Registered",
"state": "AZ",
"license": "8608987",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Poway, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 15, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.